External monitoring and control of the certain complex systems is an important yet complex and difficult problem in many situations. For example, external monitoring and control of the circulation is an important yet complex and difficult problem in humans and other mammals, particularly in acutely disordered and severely diseased states. It is one of the most commonly performed tasks in human and veterinary intensive care units and other areas of critical care including anesthesia and emergency care. The task involves the measurement of variables relating to the circulation including blood pressures, blood flows (cardiac output), heart rate, and oxygen levels. In current clinical practice, a physician (or veterinarian) or nurse interprets the measured data and applies various diagnostic and therapeutic interventions. Typical therapies include infusion of volume (e.g., in the form of normal saline), diuretics, vasoconstrictors and vasodilators, and medications that affect the strength, rhythm or relaxation of the heart. One of the aims of this clinical task is to maintain the circulatory state at a desired level. This desired level is usually articulated in the patient record, but not always consistently. The purpose of the desired state is to ensure adequate blood and oxygen perfusion to vital tissues and removal of metabolic products.
Current circulatory management relies primarily on the education, training and experience of the bedside clinician team, which in practice has produced high variability in approaches and results. A common concept is that of pre-load. One definition of pre-load in cardiac physiology is the pressure stretching the ventricle of the heart, after passive filling and atrial contraction. If the chamber is not mentioned, it is usually assumed to be the left ventricle. For example, if the pre-load is low, then an increase of circulating blood volume may be indicated (by increased administration of normal saline or volume expander). Unfortunately, pre-load is a qualitative concept and not a quantitative measure and there are numerous different definitions of pre-load.
Some intensive care units are beginning to introduce paper protocols for circulatory management. However, the most common practice is that of individual interpretation of the varying monitored data and judgment on therapy change.
A number of problems arise from current practice. A wide variety of circumstances including acute subject problems, complexity, clinical inexperience, lack of vigilance and confusion over the desired state can result in the circulation entering areas compromising a subject's wellbeing. This may require extra clinical effort, medications and time to return the circulation to a more desirable state. Furthermore, the perturbed state may itself entail side effects, for example, atrial fibrillation in an overpowered circulation and/or shock and organ failure if pressures and flows are insufficient. These side effects increase morbidity, prolong time in intensive care, increase the risk of death and add considerably to the costs of care.
A need therefore exists to provide methods, systems and/or devices for improving guidance and/or control in certain systems such as complex systems. A need also exists to improve the clinical process of improving circulatory guidance and/or control of unstable circulations in warm blooded animals and provide related methods, systems and/or devices. A need also exists to improve the critical care clinical process of monitoring, treating, and/or improving circulatory guidance and/or control of unstable circulations in warm blooded animals and provide related methods, systems and/or devices. A need also exists to provide methods, systems and/or devices for improving circulatory guidance and/or control in subjects, thereby reducing, among other things, the hazard associated with side effects. A need also exists to improve the clinical process of improving circulatory guidance and/or control by systematizing the care of unstable circulations and/or supporting a team approach to such care. The present disclosure provides various combinations of systems, methods, and/or devices for the care, the guidance and/or the control of certain types of systems. Certain embodiments may also produce better end results for the systems.